This week BBC2′s Horizon series continues with ‘Pill Poppers’, an investigation into our use of drugs. From the programme’s website

Over your lifetime you are likely to be prescribed more than 14,000 pills. Antibiotics, cholesterol lowering tablets, anti-depressants, painkillers, even tablets to extend your youth and improve your performance in bed… These drugs perform minor miracles day after day, but how much do we really know about them?

Drug discovery often owes as much to serendipity as to science, and that means we learn much about how these medicines work, or even what they can do, when we take them. By investigating some of the most popular pills we pop Horizon asks – how much can we trust them to do what they are supposed to?

I was invited to participate in the programme to discuss sex drugs and the medicalisation of sexuality. This covers a wide area, not all of which was possible to cover in the programme, so here’s an overview of this issue.

Medicalisation of sex has a long history – explained thoroughly here, and while we undoubtedly welcome the benefits of antibiotics for sexually transmitted infections, the more recent phenomena of medicalising sexual functioning is more worrying.

The best known sex drug is, of course, Viagra. Aimed at tackling erectile dysfunction in men it has morphed from a drug for a chronic clinical condition to a ‘lifestyle drug’ often wrongly understood to be an aphrodisiac. Other drugs for ED soon followed – Cialis and Levitra, with more in development. A discussion of the 10 year history of Viagra can be found here.

Given the huge profit made from erectile dysfunction drugs, the race was on to find additional sex drugs and over the past few years we’ve seen a lot of hype about sprays that would boost desire, Viagra’s use in women, and testosterone treatments for women. Which either did not proceed past trial stage (in the case of the first two examples), or was licenced for public use but not found to be clinically effective (in the case of the latter example). There’s also the growing market of herbal sex products mostly sold online but also stocked in high street stores. Not to mention the private clinics using bullying tactics to persuade men to buy their ‘cure’ for premature ejaculation.

Over the past 15 years there’s also been a major shift to categorise a lack of desire in women as a clinical disorder requiring medical treatment, the most recent development being the ‘desire drug’ Flibanserin.

For Horizon’s ‘Pill Poppers’ I was keen to outline how some sex drugs (such as the contraceptive pill or antibiotics for sexually transmitted infections) have undoubtedly enhanced our lives. But the medicalisation of sexual behaviour is another matter. While I agree men with chronic erectile dysfunction as a result of a health problem such as MS or diabetes benefit from an erectile dysfunction drug, attempts to classify a lack of desire have proved highly problematic.

There are many things that can cause sexual problems for women and men (gay or straight), including:
- Physical or mental health problems (such as diabetes, heart disease or depression, cancer)
- Gynaecological or urinary problems (including thrush, cystitis, sexually transmitted infections)
- Relationship problems (such as arguments, jealousy or communication difficulties)
- Stress (from too much work or workplace problems, being overloaded with housework, a lack of partner support, or financial worries)
- Not knowing or being able to effectively explore or communicate what turns you on
- Lack of privacy for sex
- Concerns over pregnancy (worries about getting or not getting pregnant)
- Past or current physical, emotional or sexual abuse
- Body image or confidence issues
- Lack of sex education or holding negative beliefs about sex

These can be short or long term problems and may resolve themselves or require the assistance of a therapist or healthcare practitioner. The idea that a lack of interest in sex should be immediately approached with a pill means the multiple contributory factors to sexual problems may well be missed – resulting in any medication being largely ineffective.

It’s worth noting, as Pill Poppers airs, that despite the media hype we only currently have drugs legally available to treat erectile problems. Although from the media hype around drugs in the pipeline (at trial stage) you’d be forgiven for thinking there’s more products available. You’d also be forgiven for thinking no drugs means no support or help for psychosexual problems, which isn’t true. Therapy and other healthcare interventions can do a lot to help.

So my advice is if you are worried about your sex life, identify what the cause of any problems might be before thinking you’ve a clinical condition. Of course if you’re in pain or distress you should speak to a doctor or therapist, but it may well be that while you have a problem it isn’t necessarily one a pill would fix.

After all they’ve yet to make a pill that makes your partner romantic, or keen to share all the household chores.